A Multi-Country Needs Assessment on MCL and CLL Management

Do oncologists/hematologists have what it takes to manage the wave of new therapies that have been approved over the past decade to treat mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL)?

In short, it varies a lot—by country and by setting, according to findings from a cross-sectional study published this month in Cancer Reports by Lazure and colleagues.¹

Funded by Eli Lilly through AXDEV Global, the study surveyed 285 oncologists, hematologists, and hematologist-oncologists across 5 countries (US, France, Germany, UK, and Brazil) to assess knowledge, skills, and confidence gaps in managing relapsed/refractory MCL and CLL. To participate, physicians were required to have at least 2 years of post-residency experience prescribing Bruton tyrosine inhibitors (BTK) inhibitors to patients with CLL or MCL.

The study builds on a previously published first-phase analysis from the US, France, and Germany only. Beside adding in data from 2 additional countries, this phase included a new focus on patient engagement and shared decision-making, both of which are increasingly important to US payers, including Medicare.

MCL-Specific Findings Stand Out

More than half of respondents (54%) reported suboptimal skills monitoring and managing side effects from chimeric antigen receptor (CAR) T-cell therapy in MCL. Deficits were most pronounced in community settings in Germany (72%) and Brazil (77%). By comparison, skills gaps around BTK inhibitor management in MCL affected 30% of respondents.

When it came to adjusting treatment based on guideline recommendations and patient preferences due to tolerance or toxicity issues, 42% reported suboptimal skills for MCL specifically, compared with 33% for those treating CLL. Reports of suboptimal skills in this area of MCL treatment rose to 53% among academic-setting physicians in France and 50% in UK community settings.

The authors attribute much of this MCL-specific gap to uneven global access and regulatory timelines for newer therapies such as CAR T-cell therapies, which were approved in the US as early as 2017 but only very recently in Brazil. “Approval of a novel therapy may occur long before it is integrated into national or international guide­lines, institutional protocol, and clinical prescribing practices,” the authors explained.

Results Among Those Treating Patients With CLL

Knowledge gaps in CLL centered on adverse-effect profiles of newer agents: 49% of respondents reported suboptimal knowledge of noncovalent BTK inhibitor adverse-effect profiles, with these levels reaching 68% in Brazil and 70% in the UK; overall, 34% reported gaps regarding BTK inhibitors approved after 2018. Nearly half of all participants (49%) disagreed with a statement asserting that BCL-2 inhibitors and BTK inhibitors share similar adverse effect profiles but differ in overall survival, reflecting inconsistent understanding of comparative risk.

There was also notable disagreement about the risk-benefit ratio of BTK inhibitors in anticoagulated CLL patients, with roughly a quarter believing risks frequently outweigh benefits despite evidence supporting safe coadministration. Skills gaps in CLL were comparatively smaller than for MCL/CAR T: 31%–33% of respondents reported suboptimal skills in risk stratification, weighing patient preferences against guidelines, and incorporating guideline updates into treatment adjustments, with Germany's community setting again showing elevated gaps (up to 43%).

Shared Decision-Making Emerged as a Cross-Cutting Weakness

Fifty-eight percent of respondents said they never, rarely, or only sometimes considered patients' concerns about treatment safety, and 42% said the same about adverse-effect management concerns and treatment adherence likelihood. Twenty-five percent rarely or never asked patients about their therapy preferences at all, rising to 47% in France. Confidence in discussing risks, benefits, overall survival, and progression-free survival was suboptimal for 21% of respondents overall (28% in France). These findings suggest that even where clinical knowledge exists, translating it into patient-centered conversations remains inconsistent—a gap the authors say wasn't fully captured in the smaller first-phase sample.

The authors identified this as an area begging for improvement. “Patients have indicated a desire for education and support in self-management practices,” they wrote, adding that alhtough patients report positive experiences with BTK inhibitors and venetoclax, they also experience significant adverse effects. “Side effect management and communication and collabora­tion are known areas where [oncologists/hematologists] and other providers struggle.”

“Communication with patients to encourage disclosure of those side effects and how they impact their ex­perience and quality of life is important, as are the sometimes neglected discussions of patient preferences,” they continued. “These top­ics should be approached in an effort to ensure adherence to treatment, which is key for this patient population who some­times require continuous therapy.”

Community-based Settings Consistently Showed Gaps

Results from community providers likely reflect differential access to clinical trials, specialist consultation, and continuing education. Country-level variation was substantial, but the study was not statistically powered for cross-country comparison, so the authors presented their findings descriptively.

The authors conclude that continuing medical education should prioritize MCL-specific side-effect management—especially for CAR T-cell therapy—alongside broader efforts to build clinician skills and confidence in shared decision-making. Limitations include a low 1.8% survey response rate, self-reported (rather than objectively assessed) competence, and the absence of patient or nursing perspectives.

Reference

Lazure P, Eyre TA, Niemann CU, et al. Treatment, monitoring, and management of patients with relapsed/refractory chronic lymphocytic leukemia and mantle cell lymphoma: evidence from a multi-country needs assessment. Cancer Rep (Hoboken). 2026;9(8):e70655. doi: 10.1002/cnr2.70655.